Monday, October 28, 2013

Ten Items...or less

One of the lesser well-known provisions of the Patient Protection and Affordable Care Act is that insurance policies must provide coverage for ten specific items.  They are:

(A) Ambulatory patient services.
(B) Emergency services.
(C) Hospitalization.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder services, including behavioral health treatment.
(F) Prescription drugs.
(G) Rehabilitative and habilitative services and devices.
(H) Laboratory services.
(I) Preventive and wellness services and chronic disease management.
(J) Pediatric services, including oral and vision care.

This is an extract from the transcript of a "town-hall" that the President conducted for an audience of AARP members:

"THE PRESIDENT: Here's a guarantee that I've made: If you have insurance that you like, then you will be able to keep that insurance. If you've got a doctor that you like, you will be able to keep your doctor. Nobody is trying to change what works in the system. We are trying to change what doesn't work in the system."

You can view the entire transcript here at http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-in-AARP-Tele-Town-Hall-on-Health-Care-Reform/

These things are important in the wake of mass cancellations of health insurance plans by the insurance companies because they don't provide coverage for all ten of the mandated items above.  Now the Obama Administration and supporters of the PPACA are trying to claim that when the president told people they could keep the insurance they had, he was referring to those who get their insurance through their employer, or through programs like Medicare.

The problem with that contention is that AARP membership is open to anyone 50 years of age or older.  Because of that, it could not be safely assumed that the audience for the president's remarks was made up of people with health benefits provided by employers and/or Medicare.  I don't believe for one minute there was a deliberate attempt to mislead, but the resulting confusion is certainly easy to understand.

One California resident just had their Blue Cross policy cancelled because it doesn't cover the required items.  The cheapest "Bronze Plan" coverage this individual has been able to find, which is closest to replacing the benefits they had before will force them to pay premiums that are 65% higher than before.

Do the elderly need policies that provide a pediatric benefit or maternity benefits?  Do we all have to have coverage for mental health and substance abuse treatment?  The answer is yes, if we can to create a broader risk pool in order to make insurance affordable for everyone.  One of the major components of making the PPACA work is that the younger population is going to be subsidizing the care of the older population.  This is fair when you consider that someday those younger people will be older and benefiting from the next generation who will subsidize their healthcare.  The problem is, they don't want to subsidize their elders, they want to avoid insurance while they are young and healthy and just get coverage when they NEED it.

That is what is referred to in the insurance industry as "adverse selection" and it is one of the reasons that forcing insurers to cover pre-existing conditions is patently unfair.  I've ranted before about how insurers in all lines of coverage are providing coverage based on potential, rather than actual events.  We know that as people age, certain health conditions become more likely due to the aging process.  That's why until recently, California allowed insurers to set premiums based on age to vary by a factor of up to six times the premiums of younger people.  Now that's been reduced to only three times the lower premiums.

In order to increase the size of the risk pool, you can't provide insurance coverage on an "al a carte" basis.  It just doesn't work.  Eventually there will be only one way to make the system work, as long as adverse selection is allowed with only a relatively minor penalty being paid.  The system will mandate stiffer and stiffer penalties for those who refuse to comply with the mandate until the penalty is more than the amount of buying the insurance.  Or it can do as I've suggested before.

Minors begin needing their own coverage upon reaching the age of 19, or if they are full-time students, 26 or when they are no longer full-time students.  Fine.  Give them one chance to opt into the system, while they are young and healthy.  Make sure they understand that if they choose to opt out, they are out until they become eligible for Medicare.  That means they're out of the exchanges, out of the subsidy system and while they could choose to buy policies later, on an individual basis they are almost certainly pricing themselves out of the system for the bulk of their adult lives.

Do that and everyone will dive into the risk pool, and the PPACA will achieve its goals.

* * *

I enjoy watching "Pawn Stars" on occasion and saw an episode after I finished tutoring some students today.  Some guy had bought something at a flea market for $400 and he sold it for $4,300.  $3,900 to the good except of course that he's required to report that on his income tax return and pay capital gains tax on that profit.

It got me to thinking about how unfair parts of the capital gains tax laws are.  Not so much the part that allows people like Mitt Romney to pay a lower rate on income from long-term investments.  I'm more concerned about how the government wants to tax our gains, but wants no part of our losses when we're dealing with personal property. 

For example, suppose you bought a Corvette earlier this year for $80,000.  It was one of the last 2012 models on the lot.  Now in November, the 2014s are pushing the 2013s off the lot and you suddenly have to sell your 2012 because you need the cash.  You're going to take a big hit 10 months after purchase, probably selling for $50,000 or $60,000 if you're really lucky.  The government doesn't want to hear about your loss.

Now, suppose you bought a classic 1965 Corvette back in the 1980s.  They ran around $6,500 in 1965, fully loaded.  You paid $18,000 for it in 1984.  Now you want to sell it after having driven it rarely for the last 29 years.  You may get as little as $40,000 or more than $100,000.  Uncle Sam will most definitely be there with his hand out as you pony up 15% of the gain on the sale.

Is this fair?  Why is it that our government is ready to tax money we never expected to earn, but won't give us a write-off on "personal property" we didn't purchase as an investment?  When you sell your home, assuming you owned and lived in it for two of the last five years, the first $250,000 ($500,000 if you're married and file jointly) is excluded from being taxed.  But any profit above that level is going to generate a tax liability.  However if you were hurt by the housing bubble and sold at a loss, Uncle Sam has no sympathy and no write-off for you.

What do you think?

* * *

Random Ponderings:

If there is a wild side to Heaven, that is where Lou Reed is walking tonight.

Does Harvard-Westlake really have one dean for every 30 seniors?

Former Speaker of the Legislature in CA Willie Brown says it is time to scrap the ballot initiative process in our state.  He's wrong, as usual.

It is time to stop giving preferential treatment to the body surfers at the Wedge in Newport Beach.  When there were a lot of people body surfing, a preferential time was right.  Now there isn't the demand and it's time to give those riding boards access to all of the waves, all of the time.

Dick Cheney telling people he knows what the Republican party needs makes me chuckle.  He hasn't a clue as to what they need to do.  Not when he's supporting the agenda of the Tea Party.

I always thought Shaq was kind of conservative politically and now he's endorsed Governor Chris Christie for reelection in the upcoming Governor's race in New Jersey.  We'll see what happens with Christie in the 2016 Presidential derby and see if Shaq backs him again.

A number of states ban payday loans, since these loans may violate the state's law on how high interest rates can go.  But internet lenders operate in those states illegally and are now pushing collection agencies to go after those who take out these loans and then fail to make repayment.  New York City is now coming down hard on these collection agencies for their apparently illegal actions.

Worst of the "sexy" Halloween costume this year is the attempt at a sexy "Luigi" from Mario Brothers.

* * *

This Date In History:

312 – Constantine the Great is said to have received his famous Vision of the Cross.
710 – Saracen invasion of Sardinia.
939 – Edmund I succeeds Athelstan as King of England.
1275 – Traditional founding of the city of Amsterdam.
1524 – Italian Wars: The French troops lay siege to Pavia.
1553 – Condemned as a heretic, Michael Servetus is burned at the stake just outside Geneva.
1644 – Second Battle of Newbury in the English Civil War.
1682 – Philadelphia, Pennsylvania is founded.
1795 – The United States and Spain sign the Treaty of Madrid, which establishes the boundaries between Spanish colonies and the U.S.
1806 – The French Army enters Berlin, following the Battle of Jena.
1810 – United States annexes the former Spanish colony of West Florida.
1827 – Bellini's third opera Il pirata is premiered at Teatro alla Scala di Milano
1838 – Missouri governor Lilburn Boggs issues the Extermination Order, which orders all Mormons to leave the state or be exterminated.
1870 – Marshal François Achille Bazaine surrenders to Prussian forces at the conclusion of the Siege of Metz along with 140,000 French soldiers in one of the biggest French defeats of the Franco-Prussian War.
1904 – The first underground New York City Subway line opens; the system becomes the biggest in United States, and one of the biggest in world.
1907 – Černová massacre: Fifteen people are killed in the Hungarian half of Austria-Hungary when a gunman opens fire on a crowd gathered at a church consecration. This would led to protests over the treatment of minorities in Austria-Hungary.
1914 – World War I: The British super-dreadnought battleship HMS Audacious (23,400 tons), is sunk off Tory Island, north-west of Ireland, by a minefield laid by the armed German merchant-cruiser Berlin.
1916 – Battle of Segale: Negus Mikael, marching on the Ethiopian capital in support of his son Emperor Iyasus V, is defeated by Fitawrari abte Giyorgis, securing the throne for Empress Zauditu.
1922 – A referendum in Rhodesia rejects the country's annexation to the South African Union.
1924 – The Uzbek SSR is founded in the Soviet Union.
1930 – Ratifications exchanged in London for the first London Naval Treaty, signed in April modifying the 1925 Washington Naval Treaty and the arms limitation treaty's modified provisions, go into effect immediately, further limiting the expensive naval arms race among its five signatories.
1936 – Mrs Wallis Simpson files for divorce which would eventually allow her to marry King Edward VIII of the United Kingdom, thus forcing his abdication from the throne.
1944 – World War II: German forces capture Banská Bystrica during Slovak National Uprising thus bringing it to an end.
1948 – Léopold Sédar Senghor founds the Senegalese Democratic Bloc.
1953 – British nuclear test Totem 2 is carried out at Emu Field, South Australia.
1954 – Benjamin O. Davis Jr. becomes the first African-American general in the United States Air Force.
1958 – Iskander Mirza, the first President of Pakistan, is deposed in a bloodless coup d'état by General Ayub Khan, who had been appointed the enforcer of martial law by Mirza 20 days earlier.
1961 – NASA tests the first Saturn I rocket in Mission Saturn-Apollo 1.
1961 – Mauritania and Mongolia join the United Nations.
1962 – Major Rudolf Anderson of the United States Air Force becomes the only direct human casualty of the Cuban Missile Crisis when his U-2 reconnaissance airplane is shot down in Cuba by a Soviet-supplied SA-2 Guideline surface-to-air missile.
1962 – A plane carrying Enrico Mattei, post-war Italian administrator, crashes in mysterious circumstances.
1964 – Ronald Reagan delivers a speech on behalf of Republican candidate for president, Barry Goldwater. The speech launched his political career and came to be known as "A Time for Choosing".
1967 – Catholic priest Philip Berrigan and others of the Baltimore Four protest the Vietnam War by pouring blood on Selective Service records.
1971 – The Democratic Republic of the Congo is renamed Zaire.
1973 – The Cañon City meteorite, a 1.4 kg chondrite type meteorite, strikes in Fremont County, Colorado.
1979 – Saint Vincent and the Grenadines gains its independence from the United Kingdom.
1981 – The Soviet submarine U 137 runs aground on the east coast of Sweden.
1986 – The British government suddenly deregulates financial markets, leading to a total restructuring of the way in which they operate in the country, in an event now referred to as the Big Bang.
1988 – Ronald Reagan decides to tear down the new U.S. Embassy in Moscow because of Soviet listening devices in the building structure.
1991 – Turkmenistan achieves independence from the Soviet Union.
1992 – United States Navy radioman Allen R. Schindler, Jr. is brutally murdered by shipmate Terry M. Helvey for being gay, precipitating first military, then national, debate about gays in the military that resulted in the United States "Don't ask, don't tell" military policy.
1994 – Gliese 229B is the first Substellar Mass Object to be unquestionably identified.
1995 – Latvia applies for membership in the European Union.
1995 – Former Prime Minister of Italy Bettino Craxi is convicted in absentia of corruption.
1997 – October 27, 1997 mini-crash: Stock markets around the world crash because of fears of a global economic meltdown. The Dow Jones Industrial Average plummets 554.26 points to 7,161.15.

Famous Folk Born On This Date:

Isaac Singer
Stevens T. Mason
Theodore Roosevelt
Emily Post
Dylan Thomas
Nannette Fabray
Ralph Kiner
Ruby Dee
Warren Christopher
H. R. Halderman
Sylvia Plath
Floyd Cramer
Neil Sheehan
John Cleese
John Gotti
Lee Greenwood
Ivan Reitman
Carrie Snodgrass
Fran Leibowitz
Jayne Kennedy
Debra Bowen (my favorite politician)
Simon Le Bon
Rick Carlisle
Marla Maples
Patrick Fugit
Andrew Bynum

Since Patrick Fugit shined in "Almost Famous", that is the source of movie quotes for October 27th.

Penny Lane: How old are you?
William Miller: Eighteen.
Penny Lane: Me too! How old are we really?
William Miller: Seventeen.
Penny Lane: Me too!
William Miller: Actually, I'm sixteen.
Penny Lane: Me too. Isn't it funny? The truth just sounds different.
William Miller: I'm fifteen.

#2

Russell Hammond: I am a golden god!

#3

Russell Hammond: I never said I was a golden god... or did I?

#4

Russell Hammond: [Russell grabs phone away from William] Hey, mom! It's Russell Hammond. I play guitar in Stillwater. Hey, how does it feel to be the mother of the greatest rock journalist we've met? Hello? Hello...? Look, you've got a really great kid here. There's nothing to worry about. We're taking good care of him, and you should come to the show sometime - join the circus...
Elaine Miller: Hey, hey, listen to me, mister. You're charm doen't work on me - I'm on to you. Of course you like him...
Russell Hammond: Well, yeah...
Elaine Miller: He worships you people. And that's fine by you as long as he helps make you rich.
Russell Hammond: Rich? I don't think so...
Elaine Miller: Listen to me. He's a smart, good-hearted fifteen year old kid with infinite potential.
Russell Hammond: [Russell is stunned]
Elaine Miller: This is not some apron-wearing mother you're speaking with - I know all about your valhalla of decadence and I shouldn't have let him go. He's not ready for your world of compromised values and diminished brain cells that you throw away like confetti. Am I speaking to you clearly?
Russell Hammond: Yes - yes, ma'am...
Elaine Miller: If you break his spirit, harm him in any way, keep him from his chosen profession which is law - something you may not value, but I do - you will meet the voice on the other end of this telephone and it will not be pretty. Do we understand each other?
Russell Hammond: Uh, yes, ma'am...
Elaine Miller: I didn't ask for this role, but I'll play it. Now go do your best. Be bold, and mighty forces will come to your aid. Goethe said that. It's not too late for you to become a person of substance, Russell. Please get my son home safely. You know, I'm glad we spoke.
[Elaine hangs up]
Russell Hammond: [Russell stands holding phone in stunned silence]

Russell Hammond: Your mom kind of freaked me out.
William Miller: [places hand on Russell's shoulder] She means well.